ArticleNature communications2018
Antifungal tolerance is a subpopulation effect distinct from resistance and is associated with persistent candidemia.
Article in Nature communications, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 179 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
179 citing papers in PubMed, 254 citations in OpenAlex.
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- Isw2-mediated chromatin remodeling governs antifungal tolerance and heteroresistance in Candida albicans.npj antimicrobials and resistance · 2026Article
- Disruption of thePathogens (Basel, Switzerland) · 2026Article
- F2F-202, a Selective Histone Deacetylase 6 (HDAC6) Inhibitor, Behaves as an Arrow with Multiple Tips against Azole-ResistantACS infectious diseases · 2026Article
- Effect of sequential laboratory passaging on virulence factors traits and antifungal susceptibility variation in Candida albicans clinical isolates.BMC microbiology · 2026Article
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- Peroxin Pex8 couples stress responses, antifungal tolerance, and virulence regulation inAntimicrobial agents and chemotherapy · 2026Article
- Antifungal Activity ofInternational journal of molecular sciences · 2026Article
- Instability and Subpopulation Dynamics of Azole Trailing Phenotypes in Clinical Candida tropicalis Isolates.Mycopathologia · 2026Article
- Species-Specific Susceptibility of Planktonic and Biofilm Forming Candida Strains to Cyclodextrin-Encapsulated Essential Oils.Pharmaceutics · 2026Article
119 more citing papers are in PubMed but not listed here.
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Authors and funding
10 authors at 4 institutions in 3 countries.
Funding
Abstract
Tolerance to antifungal drug concentrations above the minimal inhibitory concentration (MIC) is rarely quantified, and current clinical recommendations suggest it should be ignored. Here, we quantify antifungal tolerance in Candida albicans isolates as the fraction of growth above the MIC, and find that it is distinct from susceptibility/resistance. Instead, tolerance is due to the slow growth of subpopulations of cells that overcome drug stress more efficiently than the rest of the population, and correlates inversely with intracellular drug accumulation. Many adjuvant drugs used in combination with fluconazole, a widely used fungistatic drug, reduce tolerance without affecting resistance. Accordingly, in an invertebrate infection model, adjuvant combination therapy is more effective than fluconazole in treating infections with highly tolerant isolates and does not affect infections with low tolerance isolates. Furthermore, isolates recovered from immunocompetent patients with persistent candidemia display higher tolerance than isolates readily cleared by fluconazole. Thus, tolerance correlates with, and may help predict, patient responses to fluconazole therapy.
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